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COURT OF CRIMINAL APPEALS
RE LA~o~,
MAY 15 2015
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Plaintiff's name and ID Number
.,-De__:! DA--L~€& F?~¢-t-tLx'f'l
Place of Confmement
CASE NO.-'--t_0_1_;_'1_~-~---
(Clerk will assign the number)
v.
APPLICATION TO PROCEED
IN .FORMA PAUPERIS
Defendant's name and address
I, t5n.Au Lro ~Do~D deClare, depose, and say I am the Plaintiff in the above entitled case. In support
of my motion to proceed without being required to prepay fees, costs, or give security therefor, I state because of my
poverty, I am unable to pay in advance the filing fee for said proceedings or to give security for the filing fee. I believe I
am entitled to relief.
I, further declare the responses which I have made to the questions and instructions below are true.
1. . Have you reCeived, within the last 12 months, any money from any of the following sources?
a. Business, profession or from self-employment? Yes 0 No~
b. Rent payments, interest or dividends? Yes 0 No L1
c. Pensions, armuities or life insurance payments? Yes 0 No JZ(
d. Gifts or inheritances? Yes 0 No~
e. Family or friends? Yes 0 No~ ..
f. Any other sources? Yes 0 No~
If you answered YES to any of the questions above, describe each source of money and state
the amount received from each during the past 12 months. ·
2. Do you own cash, or do you have money in a checking or savings account, including any funds
in prison accounts?
Yes 0 No~
If you aD.swered YES to any of the questions above, state the total value of the items owned.
1
)~ATCIFP (REV. 9/(Jl)
, ..
3. Do you own real estate, stocks, bonds, note; automobiles, or other valuable property, excluding
ordinary household furnishings and clothing?
Yes 0 Noef'
If you answered YES, describe the property and state its approximate value.
I understand a false statement in answer to any question in this affidavit will subject me to penalties for ·
perjury. I declare (certify, verify, or state) under penalty of perjury that the foregoing is true and correct
(28 u.s.c. §1746).
Signed this the __«;_~_· __day of !\-1&--:} . '20_15.
Signature of Plaintiff ID Number
YOU MUST ATTACH A CURRENT SIX (6) MONTH IDSTORY OF
YOUR INMATE TRUST ACCOUNT. YOU CAN ACQUIRE THE
APPROPRIATE INMATE ACCOUNT CERTIFICATE FROM THE
LAW LIBRARY AT YOUR PRISON UNIT.
2 ~ATCIFP (REV. 9/02)
TEXAS DEPARTMENT OF CRIMINAL JUSTICE
RECORDS RELEASE
AUTHORIZATION
I, the below named and numbered offender, hereby authorize the Texas Department of Criminal
Justice to · release· records· pertaining ·· to·" my ··trust fund account, as requested by
Gu.r t oi ((!IIVl;~ / &ppec.{ Js (Identify Court, Attorney, or entity as
defined in Rule 3 9 2 !-Special Correspondence Rules)
I, offender t)~o.u Ii 0 Jose AJo rVl 0 ' - TDCJ# ·13/ 8t/l l
being presently incarcerated at the Da./ ~J'e:!j ~LA '{)·b!!J County, Texas
declare under penalty of peijury that the foregoing is true and correct
Executed on this the 1
., I Ei
day of AIQlf'; l 20K
-------L---------- ~
By. Q!wltlr A. (Offender Signature)
Witness -Cnrlu. iJ . lJlfYY\fY)\&Y
(Approved-Witnessing Authority Signature)
INSTRUCTIONS:
1 The offe:nder completes above information, signs and dates the
Records Release Authorization in the presence of the approved
witnessing authority (Access to CourtS Representative)
2 The witnessing authority identifies the offender by ID card or
records lmd, upon verification, witnesses the offender's signature
by signing the Records Release Authorization, which the
witnessing authority will maintain
3 The witnessing authority prints out a copy of the offender's
''TFBA" computer screen, certifies it, and retains a duplicate copy
for their records
4 The offender is required to have an addressed, stamped envelope
:prepared for mailfug 'The witnessing 'authority then places a copy
of the c·~rtified "TFBA" printout in the addressed and stamped
envelope and the envelope is sealed and placed in the outgoing
mail
. ·,
.;. • • •• . :.;;; ~- ~ f '.t
ATC01- Authorization No.1 (10/01)
CSINIB02/CINIB02 TEXAS DEPARTMENT OF CRIMINAL JUSTICE 05/ll/l::'i
DH31/SD00116 IN-FORMA-PAUPERIS DATA
JDCJ#': IZ11378697 SID#: 07508892 LOCATION: DALHAfH INDIGENT DTE: 02/15/12
NAME: ADORNO,BRAULIO JOSE BEGINNING PERIOD:
PREVIOUS TDCJ NUMBERS:
CURRENT BAL: 0.00 TOT HOLD AMT: 0.00 3MTH TOT DEP:
f.MTH DEP: 6MTH AUG BAL: 5MTH AVG DEP:
MONTH HIGHEST BALANCE TOTAL DEPOSITS MONTH HIGHEST BALANCE TOTAL DEPOSITS
PROCESS DATE HOLD AMOUNT HOLD DESCRIPTION
NO BANKING ACTIVITY
WITHIN THE PAST 6
MONTH PER I [JD.
STATE OF TEXAS COUNTY OF t!o.d~.
ON THIS THE _ll
DAY OF _1Y:Y1::~\____ ,,~
_ , I CERTIFY THAT THIS DOCUMENT IS A TRUE,
COMPLETE,AND UNALTERED COPY-lADE BY ME OF INFORMATION CONTAINED IN THE
COMPUTER DATABASE REGARDING THE OFFENDER'S ACCOUNT. NP SIG:
PF1-HELP PF3-END ENTER NEXT TDCJ NUMBER: OR SID NUMBER:
-0~~.~
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